Terry Dubrow: The Truth About Plastic Surgery | E176

19:36Randall Kaplan:Okay, for everybody watching the show right now and listening, we are coming back to the housewife story. I've got so many people. You've got to ask Terry about the housewife. You've got to ask about Heather and the housewife. So we're coming back to that. I'm sorry, but I had to tell you how I met Paul. Yeah, no, it's perfect. The Paul thing. It's perfect. So it reoriented your practice, essentially, because you went from doing routine procedures to reinventing yourself, essentially doing things that were passionate and difficult. Yeah. So the first season, they sent us all these potential candidates.

20:08And I said to Paul, I go, I can't. We can't fix that. We can't fix it. So we like turned down like 98 percent and took the ones that looked bad. We thought maybe we had a chance to fix and we fixed them and it worked. And then the second season, we started to take more difficult cases. And all of a sudden, we got 10 ,000 hours doing the most impossible plastic surgery. And it became easy.

20:30Randall Kaplan:So Botched aired for eight seasons. And now you're doing a rewind. And Botched. Has it been picked up again? Well, I can't announce that officially. Oh, yeah. People will be excited. My wife will be thrilled. You can look forward to more Botched. Crazy things happen on that show. Yeah. What's the most? And when I watch it for the first time, I mean, a lot of people don't like gore. Right. My wife, I like watching murder mysteries. And, you know, whenever she walks into the bedroom at night, someone's getting shot. Their head is getting blown off, whatever the case may be. But yet here we are and she's watching things on botch that I'm having a hard time watching.

21:09Randall Kaplan:Oh, this is so cool. So cool. It ended up being cool for me. I thought, OK, well, this is interesting. You learn a lot about human nature. And we'll talk about the mental things that that go through a lot of these patients. But what was the most difficult case that you had on botched? So there was this woman who came in season three who had had illegal substances injected into her face at one of these sort of plumping parties they have. And some, they called her the madam, used to go to a hardware store and get caulking material and tell patients it was regular filler and inject it into their face.

21:46And she started to grow these granulomas, these inflammatory masses in response to them. So she came in season two or three with a giant, and we knew we were going to turn her down. We already knew that because too dangerous. You kill the skin, injure the nerves, make it worse, reignite more of an inflammatory response. So we brought her on and I met her and I went, oh my gosh, I can't believe she has to live like this. So the season ends and for the next five months between season three and season four, I wake up every morning at 4 a.m. and just think about what can I do for her? And then I had an epiphany and I figured out how to address it.

22:31And the main the concept is, why am I trying to remove all of it? Just remove the central seven eights, leave the skin above it intact, leave the nerves below it intact. and you have bones that are regular anyway. As long as you can't see it, even if you can feel it, she'll look normal. So I brought her back on the show the next season and I borrowed my buddy's orthopedic tools, his saws, and I sawed out the concrete. I lifted up her face and sawed out the concrete and it worked. So that was my riskiest and most sort of successful, impossible rescue on Botched.

23:05Randall Kaplan:And you tell people before surgery, like a lot of surgeons do, you could die from the surgery. Oh, yeah. So they sign all kinds of forms. Have any of your patients died after surgery? No. I've been very fortunate. I've had maybe seven or eight patients who've had blood clots in their legs who spread to their lungs. And I'm very paranoid. One thing about being on television, it imbues in you a certain level of both social and career paranoia. And you're stupid if it doesn't. But for me, it does. It makes me extremely paranoid. So if my patient, I see all my patients many, many times immediately after surgery.

23:46And if they call with any kind of complaint, come in, got to see you or go to the ER right now. And so all seven or eight of those have made it to the ER, were put on anticoagulants and survived.

23:58Randall Kaplan:You do life-saving surgeries for people. And I think today's environment, people think about mental health in a way they didn't used to before. 20 years ago, it's like, oh, you know, you're depressed, get over it. Today, you see a lot of suicides from what appear to be normally healthy people, people who commit suicide without warning because they haven't told people. What percentage of patients do you think whose lives you're saving because they're mentally suffering so much that they want to look better? That's an interesting question. I can tell you that we've done eight seasons over 10 years.

24:35Randall Kaplan:Not just on the show, but just in... Oh, in general? Yeah, in your general practice. I mean, I'd like to think a lot, but I can't tell you how many times I've had a patient hug and cry and say that I saved their lives and that this is a restart and they can get a job now and do on. You know, I think that's been a happy part of my career. There's excess in a lot of things we do. Talk about body dysmorphic disorder. Explain to people what it is and then how that affects your practice. Yes and no. It's very tricky because body dysmorphia disorder, which people refer to also as BDD, is when a person has an extreme concern about something in their appearance that's above and beyond what they should have or even what you can see.

25:23You know, it's like a bump on a nose can be devastating and it's ruining my life when you can barely, you have to sort of turn their head to take a look at it. So it's an extraordinary level of concern about a minimal deformity. sort of kind of thing. The problem with botched, one of the scariest things with botched is that some of the patients got to where they got because they have body dysmorphia and they keep going to plastic surgeons to have more plastic surgery. And if you walk into a plastic surgeon's office, he's going to offer you surgery. And so the more -

25:58Randall Kaplan:Because of the financial incentive? Because of the financial thing, for sure. Not all, but most. Cost a shit ton of money. It costs a shit ton of money and they have expensive overheads and offices and they want to have nice lifestyles. So very few plastic surgeons turn down patients. So if you do enough surgery, ultimately the blood supply can be disrupted enough that you get infected, inflamed, destroyed, and it can die. They then come into your office as the botched doctor destroyed, but they have body dysmorphia. So under normal psychological criteria, you would never allow them to have plastic surgery.

26:36But what are you going to do? You've got to now take on the worst psychological candidate for plastic surgery. But you have to because you can't let them live the rest of their life with no nose or with a distorted face or with breasts that are contracted and look like crab claws. It can be very tricky. But I've learned how to do that.

26:58Randall Kaplan:Tell us how many patients you turn down and how actually it's ironic that no could be a phenomenal marketing strategy. Yeah, I turn down patients all the time. And one of the, now, honestly, one of the nice things about being financially secure and being extremely successful and well known as a plastic surgeon is I really don't need to operate for money anymore. It's probably smarter if I stop, to be honest with you. I don't need the risk anymore. And the potential extortion of someone saying, because if someone puts out a tweet saying, Terry Dubrow ruined me, TMZ is going to call me. within an hour.

27:37Yeah. And they're going to publish that. And that's bad, but I love it. I'm pretty good at it. And I've learned to, I call it whisper, you know, the dog whisperer. I've learned to my best ability and it's not perfect, but I've learned how to whisper patients to allow them that they're going to have plastic surgery. At least they understand they've heard what the truth is about it. And so like, like if you came in and you wanted a facelift, you do not need a facelift. Okay. But you could certainly have a facelift, right? And let's say you are the type of person who did this. You go, I just love the way this looks.

28:18And I go, yeah, but you're going to look like a guy with a facelift. Okay. You don't have this. Okay. This can use a facelift, but not you. For example, I would say, let me just tell you something. You look great. You're really not going to look better. You're going to look altered. You're going to look weird. You're going to have scars and you're going to look like a dude who had plastic surgery. Isn't that going to turn you off from a facelift? Are you going to have a facelift after I say that? No. Probably not. Not doing that. How many plastic surgeons are going to say that to you? Not. I promise you, you go to 10 plastic the best plastic surgeons in Beverly Hills, you're getting 10 pre-ops.

28:5510 people wanting to operate on you. Tomorrow, they're going to do a facelift on you. So that protects me from a lot. And then if I get the body dysmorphia patient who needs to have this thing fixed because it's a true deformity, I go, okay, let's play a game here. I operated on you and it's worse. Where are we going to go from there? Oh, you're the botch doctor. It's not going to be worse. I go, nah, it's a scalpel, not a magic wand. Okay. This is not a magic trick. I go, I go, but what if it goes badly? How are we going to handle that? Are you going to go crazy on me? Are you going to go in the hospital?

29:37What are, what's our backup plan if it goes badly? So, and if they say, I'm not worried, it's you, I won't operate on them. But if I can come to some meeting of the minds and agreement that I can feel comfortable with that if it does go badly, we'll work through it, then I'll operate on them.

29:57Randall Kaplan:It can be dangerous. And I want to talk about Kim Kardashian, who's one of the most famous people in the world. She's got 455 million followers on Instagram. And people are obsessed with her ass. And Brazilian buttless are some of the most popular forms of plastic surgery. And they're also the most dangerous form of plastic surgery. So maybe talk to us about what happens to make them so dangerous. And what's your advice to all the women out there who want the big ass? Well, so as you probably know, I'm not a fan of the Brazilian buttock lift. And all it is, it's very simple. You take fat from one part of your body through liposuction and inject it into the buttock to make it fuller.

30:41Sounds easy, right? The problem is there are very short, big blood vessels in the buttock that are directly connected to the main vein feeding back to the heart, to the vena cava. And if you get accidental inadvertent fat injected into those blood vessels and it goes into your vena cava, it goes back to the right side of your heart, to your lungs, and it gives you a fat embolism. and that can be and is often fatal. So no operation, oh, and that happens a higher percentage of the time than is acceptable in elective surgery. Look, if you have pancreas cancer and I tell you there's a one in 3 ,000 chance you're going to die from this operation, you're still having the operation.

31:31I tell you there's a one in 2 ,000 chance you're going to dive from a Brazilian buttock lift well there's hundreds of thousands of them done it's not worth the risk so I don't do it I don't recommend anyone does it and I you know I'm waiting remember the buttocks I'm older than you but the the 70s buttocks the Bodero type Derek Pike buttocks the smaller buttocks you have a smaller buttocks let's celebrate that now let's leave it alone

31:57Randall Kaplan:yeah salute to Boderic by the way for those of us who are our generation who I think was the most beautiful woman in the world, maybe ever. Yeah. So plastic surgery is huge. How does one find a great plastic surgery? And there's so much, you know, yada, yada, yada. I mean, breast augmentation, which we're also going to talk about in a second. It's, you know, who's the best breast doctor? Who's the best nose doctor? It's even harder now than it was before because, you know, you can't judge a plastic surgeon by their before and afters because and not showing you every before and after. Right. Right?

32:35And I just think there's a few basic fundamentals that you have to check. A few boxes you have to check. You have to check board certification.

32:43Randall Kaplan:Yeah. Do you know they all have board certification? No. In Beverly Hills, all the doctors don't have it? No. Over 50 % of the doctors who do cosmetic surgery, even Beverly Hills, are not real plastic surgeons. They're cosmetic surgeons. Okay. What's the difference? I trained, I did a residency and a fellowship in plastic surgery. A lot of them are general surgeons. Got it. Or did weekend courses. So they have to be board certified, American Board of Plastic Surgery or American Board of Facial Plastic Surgery. Number two, you have to say to them, could you do this procedure in a hospital if I wanted you to?

33:16Oh, I never do it in a hospital. I do it in a surgery center. No, no, no, no. Are you allowed to do this procedure in a hospital? And if they don't say yes, that means they're not vetted. because a hospital won't let you do. Imagine what a hospital does before they take on the risk of letting you do a procedure in their hospital.

33:34Randall Kaplan:Right. So they have to have hospital privileges somewhere. Then, word of mouth, looking at their pictures doesn't really help you because I can do 1 ,000 operations and have 20 good results, and I'm going to show you all 20. Exactly. No one's putting up their worst photos. Yeah. So word of mouth, if you, the nurses know, if you can, if you know any nurses, they know friends that have had good experiences, but it's funny. I was talking to someone the other day and they were talking about this one particularly hot plastic surgeon right now in New York. He's the guy of the moment. And I, they said, oh, well they did so on and so, and then they did this person, that person.

34:18And I said, like, and I said, you know, you really can't judge it. by that necessarily because you're seeing such a small sample size of a huge piece of data that I said, if you, if we lined up our 50 of our worst results, you would never have plastic surgery from any of us. So the long, the short story is board certification, hospital privileges, word of mouth. If you can talk to people who've had surgery before with them, and then don't just go see one person, go see a few and see how much time they spend with you.

34:55Randall Kaplan:They charge you some of these people for the consultation. So you may spend five grand before you're more. The guy who's really hot right now in New York, I think is charging you five grand. For one hour to sit down with them? Yeah, if he spends an hour with you. And then I said this on season five of Botched. I looked at the page. I go, where did you find the plastic surgeon? She goes, I saw him on a TV ad and I said to her, never trust a plastic surgeon you see on TV. And we had a moment, we broke the, she looked at me and I looked and I went, ah, just kidding. You know, obviously it was unbotched.

35:30Randall Kaplan:Right, so price elasticity is important in everything that we do when we buy, right? And so the range of prices in Beverly Hills, even for example, for a breast implant surgery could be 10 ,000 on the low end. And then I just, we had a friend who paid$80 ,000 for breast augmentation, breast implants. Right. Insane? Or you get what you pay for? No. Insane. Insane. Breast augmentation is an extraordinarily easy beginner operation in plastic surgery. So don't spend more than 10 or 12. There's no difference between the guy in Culver City than the guy in Beverly Hills. It's a very, very basic operation.

36:19I will tell you, you may not be aware of this, but guys are now charging$350 ,000 to$400 ,000 for a facelift. I took care of a patient the other day, came in to see me. She had had a botched facelift in Beverly Hills. She paid$350 ,000. She went to another guy to fix it in Manhattan. He charged her$450 ,000. And it's still a disaster. And then she came to me and I'm looking at the records going, wow. wow you've paid almost including the aftercare and the hyperbaric you've paid almost a million dollars for two failed plastic surgeries you you can go to encino and find a fantastic plastic

36:59Randall Kaplan:surgeon you can find people don't know how like i i hear my wife's friends talk about this all the time you know i had a baby i want a breast lift i i you know i need breast surgery now that i'm done with kids. It's like, it's like the talk of the town. They, they, and we live in Brentwood, which is a very wealthy community. So these people will pay for whatever they need to pay within reason. Yeah. Within reason, but you know,$40 ,000 for a, you know, boob job. Yeah. Okay. No problem. That's a lot. If someone's, one thing I will tell you is someone's charging 40 ,000. If they're getting 40, 50, 60 ,000, they're probably pretty good at it.

37:37Right. So at least

37:38Randall Kaplan:And there's a wait and all that. Yeah, and you're probably waiting. You're paying for at least a minimal level of competency. But again, that's not a hard operation. Yeah, but let's talk about that. There's five FDA-approved breast implant manufacturers in the United States. And there's 1 ,000 permutations between all of those breast implants. And again, from single days, from friends of friends, they're all different, right? It's not easy. Oh, they show you a picture book. here's what I want my breast to look like they may or may not like they may have one brand they have may have another brand and I'm just going to be crude for a minute but I remember dating a woman and her breasts literally felt like coconuts yeah and I'm wondering like how on earth does that happen so the the thing that makes breast augmentation a bad operation by the way it was so unattractive yeah that it's like it just like yeah like a a little bit of touching and i don't want to be you know too forward on the show but it was like not attracted like so finished so the way i give a consult in plastic surgery for breast augmentation i say okay you know all the good all the good stuff behind breast augmentation they say right i go let me tell you all the negatives first let's get past that and then we'll talk about the good stuff.

39:01I said the problem with breast augmentation is it's the number one operation that has that will have a complication in plastic surgery. That's because we're putting a foreign body in you and the immune system will come by and put scar tissue. And no matter how good the plastic surgeon is, no matter what they tell you, it has nothing to do with him. It's all in your physiology. So you can be the best plastic surgeon who does the most difficult cases or who does the most breast augmentation, it can happen to you potentially. So you have to know that it's on the consent form. However, good news is there is a new implant that just got FDA approved here last year called Motiva, M-O-T-I-V-A, that we believe it just went through FDA approval.

39:46That doesn't mean what I'm about to tell you is true, but it appears to be true because it's been in Europe for 13 years. It has a very low hardness rate. So my recommendation to people who do breast implants these days is to look at the Motiva implants very carefully. But the coconut implants you saw had nothing to do with the surgeon.

40:06Randall Kaplan:Oh, no. But he or she picked the implants. But they have a complication. Both. They got encapsulated. It's called encapsulation, scar tissue forms. I said, and that happens 15 % of the time. And they have to be redone. They have to be redone. And by the way, you know, I think probably if there was no significant chance of capsular contracture, I probably wouldn't have a TV show. Because people try to fix it, they try to fix it again, fix it again, and then it starts to destroy the tissue. You have a lot of celebrity clients. When we were talking about this summer, you said, very risky. A celebrity has huge followings.

40:46Randall Kaplan:And like you referenced on our show today, something goes bad. I don't know. I mean, great advertising on the one hand. So, oh, yes. So if you're, if you're quote unquote, I say this, you know, with all humility, if you're a famous plastic surgeon who is being followed by TMZ and other outlets, I think it's a better idea that you don't operate on celebrities. You don't need to. They're not going to really necessarily tell anybody. And if it goes badly, you got a problem. if you're not famous you want to operate on celebrities yeah because you hope they'll tell people and that'll build your practice yeah but i remember an academy award winner came to me about 10 years ago wanting a facelift and i met her and she was kind of nice not that nice but kind of nice and it was a chip shot facelift it would have been fun to do and i went home and i I said, not in a million years am I going to do her face up.

41:42Because if it goes badly, that's me.

41:46Randall Kaplan:Operating on family members, yes, no. Your daughter had a problem with her lip when she was younger. Okay, so different blast surgeons feel differently about this, but I think what I'm about to say makes the most sense. Never operate on your family members. You lose your objectivity. You lose your perspective. unless you happen to have a particular experience and skill that is far above what other people have. So my wife had a thing in her stomach, and I don't know anybody else who can fix that. Because I've done it 117 times, and the best plastic surgeon in Beverly Hills has done it twice. So it's just, you know, you know that thing on Netflix, you know, America's Team, the thing with Jerry Jones and the Dallas Cowboys, Yeah, that's on right now.

42:34It's on right now. Troy Aikman can't throw in the rain. All right? So if it's raining, you don't really want Troy Aikman, as great as he is, to necessarily be your quarterback that day. Well, it's always raining with me. My cases are all botched. So I'm experienced. So if my kid, if I'm an expert at throwing in the rain and my kid's in the rain, I'm going to fix them, if you know what I mean.

43:01Randall Kaplan:I've heard stories. We've all heard them about wealthy Middle Eastern clients saying, I need a surgeon or a doctor. I'm going to put them on my 747. I'm going to pay them a million dollars. They're going to come in for the day and then you can go back home. Have you ever done a surgery like that? So I, among other surgeons I know, have been offered to go over there and do that. A lot of money. Yeah. You lose four days. They don't pay you a million dollars. and then what do you, so no, I never do that. But I have friends who will go there for a week and do tons of surgery, but they become very, believe it or not, they don't want to pay that much anymore over there.

43:42So my friends will go over there and make 200 grand in a six day period and it takes them 10 days to do it because they're two days over, two days back and 200 grand in 10 days is not that much for a plastic surgeon.

43:55Randall Kaplan:Your wife said she's the only wife of a plastic surgeon who does not have breast implants. By the way, we're kidding. We don't know that. We don't know every plastic surgeon's wife. I mean, I don't know. You're not taking a national poll on this? Yeah, exactly. She's kidding, obviously. She's a gorgeous woman, and she has a beautiful figure, and she's an even nicer person. Thank you. But there was a period where she did that typical Orange County, Newport Beach thing where she had four kids and then got ridiculously fit. Yeah. And she basically had nothing in her chest. She'd show this to me. I'd go, she'd go, do you think?

44:36I'd go, no, no, I don't know. I don't want to. Don't do it. And then, weirdly, with hormonal shifts and perimenopause, they came back. And it can't happen.

44:47Randall Kaplan:How is AI going to improve the future of plastic surgery? I don't think it's going to have any effect until robots learn how to have hands. You see on Instagram, and I'm not in China right now, but there are stories and reels that I see robots actually doing surgery in the operating room. That's BS, by the way. Bullshit. Bullshit. They can't, I mean, if that were true, I mean, you listen to Elon Musk, the hardest thing to do is the hand, right? They can barely move a glass of water or a pitcher of water into a glass here. To do surgery, not happening. Not true. BS. It'd be here. Obesity is a huge problem in the United States.

45:30Randall Kaplan:Ozempic is all the rage right now. You tried it to see how you're feeling. You're on it right now. I'm on Monjaro. Okay. I'm a giant fan. So why? You're very fit. Yep. Were you overweight? Yeah. So why are you doing it? So. Well, and who needs it? Yeah. So I'm fascinated with this new generation of drugs. I think this is a historic change in the treatment of obesity, which is the number one risk factor for all causes of mortality, including cancer, diabetes, neurodegenerative disorders, right? And heart disease. I got so obsessed with them and the way they work is I studied for a year. This is so typical, me and someone like you too.

46:16At this stage of my life, two years ago, I studied for the American Board of Obesity Medicine Certification Exam and I took the exam. and I'm board certified in obesity medicine. So I'm a qualified expert in these drugs and I prescribe them. But these drugs go far beyond what they do just for obesity. Because of their effects on sugar and sugars related effects on inflammation, they clearly have a very powerful anti-aging longevity effect. And now they're approved for patients who've had heart attacks, even if they're not overweight. They're approved for fatty liver disease, even if not overweight.

46:53They're about to be approved for Alzheimer's. So because of what they do to sugar and insulin sensitivity, their effects are far and above and beyond what they do for weight loss. And it was funny because I was talking to this gentleman the other day and he's on it and he had a gambling problem that's done now that he's on these drugs. So who are they for officially? therefore diabetics okay type 2 diabetics officially they have an indication for obesity if you have a BMI over 30 or over 27 with an associated comorbidity like high blood pressure but if you ask me because most of the stuff we do in medicine is off-label I think everyone should be on microdosed GLP-1s because of what they do for sugar and the inflammatory effects and sugar and how they are good for aging.

47:50Randall Kaplan:Let's talk about extreme preparation for a minute, which is one of the hallmarks of my success. Yes. Tell me a story about how extreme preparation, which I'm talking about, someone may prepare one hour for something, you prepare 20 hours. Give me a story. Tell me a story about how extreme preparation has led to something that you otherwise would not have been able to achieve. I can give you a number of examples. I'll give you just two quick ones. One is I remember when I was a chief resident in my, my last year of general surgery, where you operated independently, you took trauma call by yourself in my day.

48:24There were no professors in the hospital. It was you and the young people below you. You were it. And you're like 27. Okay. The most dangerous, scary thing. And you don't want to kill anybody in general surgery because you have to go to that morbidity, mortality conference every Wednesday and present your complications of your deaths. And the professors sit there and threaten to fire you and say things like, well, why didn't you just take a gun and shoot him? Why did you even bother operating on him? You know, I remember I was always worried about gunshot wounds to the liver because those are very, very dangerous.

48:57And so I thought, you know, I don't want to be surprised by a gunshot wound to the liver and have to do the Pringle maneuver and have to take the lobe out and get control of the hepatic vein. Very dangerous stuff that... So I would study for one and a half hour a day while I was on call, gunshot wounds to the liver and just visualize it every single day. And when you do general surgery, you're on my day, you're on call every other night, up all night operating on trauma, every other night for six months. Three months, then you do three months elective, then three months again. Very intense, very cool.

49:39I kept getting these gunshot wounds to the liver and kept saving them over and over and over again. And it was that preparation and only that preparation and visualization that allowed me to do that. That's number one. The other thing recently is I got in a fight with Jillian Michaels, the former trainer on The Biggest Loser, when these Ozempic drugs came out. She went in the media and said, those are ridiculous. They're dangerous. Don't do them. Diet and exercise said, I said, she doesn't know what she's talking. This is on TMZ. This is going viral. Jillian Michaels is a trainer. Don't get your medical advice from a personal trainer.

50:19And they're fantastic. She doesn't know what she's talking about. And they're great. And share your experience. And don't shame people who are on them. And if you can treat obesity, you're going to live longer. And so we were battling and I thought the one criticism one could have of me is that I'm not an expert in obesity medicine. So I thought, well, here I am in my mid 60s. Do I really want to do what it takes to get board certified by the American Board of Obesity Medicine? I mean, that's like a giant undertaking. So I studied literally almost two to three hours a day for a year. and then two months before the exam, I studied about six hours a day.

51:01Now my brain works pretty well and yours does, but does it work as well as it did when you were 24? Maybe. I don't know if I could stuff as much math and science. I don't know. It works well for this kind of thing, but that's all new information. I'm not an internist. That's not, that's so far outside on my specialty. So I studied and studied and took every practice exam and I got a 94 percentile on the test. All right. Another doctor would go because it's board certification. Board certification means something in medicine. It means you took an extraordinarily difficult exam and you are a true expert.

51:38And so that's to me my latest example of extreme preparation for something that I wanted to become an expert in and wanted to become a validated certified expert we got to talk about

51:51Randall Kaplan:the housewives now my daughters have been all over me i have all these questions they're phenomenal stories so tell us how lying actually got heather on the show yeah and then how someone threw a glass of wine yes on another episode and you said hey let's not do this and she says terry Too late, man. Right. So, as I said earlier, global financial crisis. Got to do something. Let's do this show. And then through that process, the housewife producers became aware of Heather and Water on the show. I came home and said, so, would you consider being on The Real Housewives of Orange County? My wife was a bona fide actress on multiple TV shows years before that.

52:41and she said absolutely not that will kill any hope i ever have of being a scripted actress again and it's cheesy and it's disgusting and all they do is fight and i go and so i call up the producer i go yes you'll do it all right yeah so then he sends over the contract and i go let's talk about this again she's i'm not talking about that housewife thing so for like three weeks maybe four weeks. We went back and forth. We argued. Yeah, I did something obnoxious. I basically stopped talking to her for about two weeks. I'd come home. Hi. She goes, really? I go, no, I'm fine. Fine. That's okay. You can be offered a spot on a hit show and you don't have to do it.

53:25That's okay. It'll just get us out there and give us a huge platform, but that's okay. And finally, she goes, fine. If you want to go on Orange County Housewives, you sign the contract. So I signed her name. I sent it off. And then like I do, typically I woke up at 4 a.m. and I go, you know what? I've never seen this show. So I go on my iPad and I go look at YouTube, Orange County Housewives, and I see the scene of this woman who at a party says like F you to the other woman and throws whine in her face and I go whoa no way we're not going on this show this is trash so I wake up and I go hey I'm so sorry forget it she goes what are you talking about I go I saw some episodes I saw some scenes I go I don't want to go on this show she goes she goes show me and I showed it to her she goes oh my god that's ridiculous but kind of funny and all of a sudden she sort of agrees to do it and I'm freaked out and I don't want to do it and the rest is history why are people so

54:34Randall Kaplan:obsessed with the housewives what is it about the show I think a couple of things one you love to judge people you know this generation of people with x and instagram it's it's really good the voyeur is voyeuristically and the ability to you know this person's losing their house they're getting a divorce, my station life's not so bad. So that's part of it. It's a comparison. You know, they say the comparison is the thief of joy. You ever heard that one where you're comparing yourself to someone more successful? Well, I think comparison sometimes may give you joy if someone is not doing as well as you are.

55:13You feel like, well, I'm all right. That's one. Two, and I'm just going to be really honest, I think the culture has changed in this country and there's a lot more meanness and a lot more hate. And there's so much hate and meanness on these shows that you can like, oh, I hate that. The most popular housewives are the most hated sometimes. Yeah. When you list the top four that I could name for you, they're the absolutely most hated people, yet they're the most popular. So superhero America has gone to supervillain America. It's much better to be a villain than it is to be a hero, like from our generation.

55:53We want to see you fail. We also want to see, you know, to be inspired. But I think it comes down to judgy hatefulness. People love it.

56:05Randall Kaplan:Yeah, we had a conversation this summer, I think a half an hour sitting at the bar. By the way, my daughter, Ariana, is, you know, pelting you with questions. She's obsessed. Heather, Heather, Heather, who's five feet away. And people are just dying to talk to Heather as well. But she knows every episode. She's watched them all three or four times. And then I explained to you that Megan Edmonds, who is on Orange County with Heather, had recommended that we apply to get into the show. And we had a conversation about this. So I think two or three years ago, three years ago, four years ago, they came to the house, interviewed us.

56:41Randall Kaplan:And I said, we're not doing it. You went through the whole thing. Well, yes and no. You bring the cameras? Oh, yeah. They had cameras and I had to sit down. You really did go down the process. But I said, well, just wait till we talk about the second time that they came at it. So, you know, the first time I said, I'm not doing it. It's embarrassed. It's not good for my career as a financial guy and respected guy in the community. I talked to friends and I just said, you know, I just I don't want people inside my house. My kids were younger at the time and said, if you do the show, we're never coming over.

57:09Randall Kaplan:We're not talking to you. It's embarrassing to them if, you know, they don't want to be part of it. So I said, OK, we're done. then last year another bite at the apple madison told me you know they want to meet with us again and i said i'm not doing the show and she said well i'm going to talk to them so they met for 10 hours terry and this is what i didn't know when i talked to you because you said because well i didn't know because i said oh you know talk to terry you talk to terry and they said you know everyone wants a show just because they're reaching out to you know 250 people you know they're talking to but i i think that she went for you know far down the line just to madison like it's not good for our family.

57:44Randall Kaplan:I don't want people in the house. I love my privacy, by the way. And, you know, no one needs to know the business. And when I said to you, I said, and, and, you know, they wanted us on, uh, below deck, same with producers. And, you know, we talked about this too. And I did the research and half the people they make out to look like clowns and half the people, you know, you could promote something. So I'm going to promote my podcast, my company, but it, you know, that didn't work out either. And you said to me, yeah, don't do it. Has it been good or bad for you it's been extraordinarily good extraordinarily good so you're advising me no and it's been great for you well by the way it's a hard no we're not doing it just to be clear yeah but um it's it's been extraordinarily good i would do it again 10 times over for us for me but i was a simple doctor okay um even though i had been on the swan it's been good we've been able to use it for for very good reasons the plat we've been able to exploit the platform um we have very good relationships with the producers but you don't need it you don't need it and it's just pure risk now the reason i don't know your wife i've never met your wife she wasn't there right she had pneumonia when we were hanging out so i don't know your wife But fame is very attractive.

59:04You know, it's the demoticization of fame. It allows anybody to be famous potentially. And when you get famous, it's hypnotic. It's sexy. It's awesome. And women that do it love it. You know, they're extracted, extracted from obscurity or not necessarily, well, relative obscurity. They may be well known within their own thing, but all of a sudden everyone knows them and you get treated, but it's very, very dangerous. And I remember there was a plastic, no, there was a surgeon in Orange County whose wife was offered it. And he says to me, can we have coffee? I go, definitely. He looks at me, he goes, should I do it?

59:52I go, let me ask you one question. I go is there anything in your past anything you can think of that if it came out would be problematic for you as a doctor they turn it down the next day we all have things in our past

1:00:10Randall Kaplan:it's all coming out but most people go on it it surprises me how many people go on it just as their relationship and their world is falling apart and they think you know the old people would have kids to try to fix their marriage and it did the opposite i tell everybody that by the way you got friends oh we're gonna have a kid like it's gonna it's gonna explode yes faster than cure you'd be shocked how many people and i don't you don't watch the show but i don't watch it either but people will come on in the middle of a bankruptcy they're trying to hide yeah on the show or in the actively committing crimes against other people and come on the show they're so hypnotized by the possibility of fame but i think you're too you don't need it i mean we're not we're not doing it i mean i think there's a reason and we talked about this too you got the bethany frankles the you know the holy grail she made all this money on her liquor brand and if you have a a company to promote like my wife has a company had a company it's in its dormancy it's a women's clothing brand called mad town but you know she's a hands-on mom she's a full-time mom, she doesn't have time to run the business, said, well, you know, it'd be great for business.

1:01:24Randall Kaplan:I said, well, yes, it would. But, you know, you don't have, I mean, you're not doing anything with the business, you know, and obviously, I mean, she was passionate about her company. It was going well, but it just wasn't like, it's, I can see why people would want to do it, but I also can see why most people would not want to do it. I mean, everyone wants to be famous until, like you said, it just takes one thing in your past and suddenly you're just, you know, you're the worst person on the planet. I can't believe you did that. Exactly. We're at the end of the show and I always conclude it with a game I play called fill in the blank to excellence.

1:02:02Randall Kaplan:You ready to play? Yeah. The biggest lesson I've learned in my life is? Find your passion and work like hell to exploit it. My number one professional goal is? To share my education training experience to allow people to live healthier and longer. My number one personal goal is? To keep my marriage strong for the rest of my life. My biggest regret is?

1:02:29This is going to sound so pathetic, but I had a whole bunch of money seeing an account doing nothing. And I almost bought Apple like 15 years ago with it. And I didn't. but I did about five years later, by the way, but that's my number. I don't have many regrets. My biggest fear is, uh, I guess my biggest fear is that with one of my kids that I won't repair the relationship with to the point where it should be.

1:03:04Randall Kaplan:You have strained relationships with your kids? One. Yeah. Just one. The craziest thing that's happened in my career is? I mean, I got a TV show that allowed me to become the most famous plastic surgeon in the world. That's the craziest thing. The funniest thing that's happened to me in my career is? I'm at a loss on that one. I can't think of anything funny that happened to me. The best advice I've ever received is? Treat your patients the way you would treat your mother. 10 years from now, I'm going to be doing? Hopefully less surgery and more content providing and content about health and wellness.

1:03:49Randall Kaplan:20 years from now, I'm going to be doing? Hopefully exercising seven days a week, hanging out and flying around in my private jet. That's a terrible thing to say. I've got to get this. I said that. If you could pick one trait that would make somebody successful, it is? Passion. Intensity. For me, intensity. The most important thing that's contributed to my success is? For sure, my intensity. My ability to focus. The one thing that I've dreamt about doing for a long time but haven't is? Having a reality show called Sudden Beauty Island, I've been wanting to do this for 30 years, where I transform people with very significant deformities, and they all fall in love with each other.

1:04:42Randall Kaplan:If you could invent one thing in the medical field, it would be... That's a good one. That's an easy one. A device that would tighten skin without cutting it. If you could go back in time and give your 21-year-old self one piece of advice, what would it be? this is pathetic buy apple buy apple stock i remember when it was a dollar 30 to be honest with all my dreams have come true every single one of them blessed yeah grateful lucky lucky grateful i can't tell you how many people who i've interviewed who have said luck is so important to their success i know it is to mine timing is everything you do create your own luck through work ethic and it takes a lot of things to be successful but i think every successful person who thinks luck wasn't a part of it is not looking themselves in the mirror oh huge and the final thing for me is always be kind always one of the greatest underrated characteristics of anybody's success is kindness yeah if i were president of the united states right now the first thing i would do is that's a very political question uh have a moratorium on hate i would i would i would form a kindness council and a civility council and just tell everybody just be nicer to everybody let's let's like say no to hate your brother kevin died of a drug overdose eventually and if you could say one thing to him today what would it be you're an asshole that's what you would say to him?

1:06:22Randall Kaplan:yeah I thought you were calling me an asshole no I couldn't tell he's looking right at me like you are an asshole no he's an asshole he's an asshole I mean he knew better there was a song by Bad Company called Shitty Star great song and I said to him I go is this gonna be you man sleeping bottles by your head died died in your bed I go is that gonna be you it's not gonna be me I go it's gonna be you dude and I go, you're going to do that to our mother. They were like this. So I just say, you're an asshole and you owe me money. If you were on your deathbed and you had 60 seconds to live and Heather and your four kids were surrounding you, what's the last thing you would say to them?

1:07:08I would say, oh, this is how you get people to cry. I get it. I would say, I had a great life. and your job for me is to have the best life you possibly can.

1:07:22Randall Kaplan:The last question is the one question you wish I'd asked you but didn't is. What's your best advice for extending your health span? And that is you've got to do at least 150 minutes of cardio a week, increase your protein, do resistance training three to five times a week, and control your sugar. and you can live longer and healthier. And if you don't, you won't. I have one final question on that because I like beer, IPA beer. Are you allowed to drink at all? Hell yes. I know you have low sugar. Okay. I mean, look, if it takes two years or three years off your life, so be it. Yeah. Definitely.

1:08:01Drink within moderation, for sure. I'm not a big sober guy person.

1:08:06Randall Kaplan:I appreciate you being on my show. This was awesome. It was great hanging with you a little this summer. You were awesome. I enjoyed it. Looking forward to hanging out with you and Heather. Yeah, yeah. Let's do the four of us. We'll do the four of us for dinner. You know, your wife's going to want to do the show and she's going to throw the gauntlet down. We're going to talk before some ground rules on the dinner. How badly does she want to do it? She doesn't want to do it now. Oh, really? It wouldn't be good for our lives. It wouldn't be good for our marriage. We have young kids. We don't want our nine-year-old and our five-year-old.

1:08:35Randall Kaplan:You don't need it. Yeah. Not going to happen. Thanks for listening and watching to my latest episode of In Search of Excellence. Be sure to like, comment, and subscribe on my social media channels. I look forward to the episode next week and I hope you listen.